Factors associated with an interruption in treatment of people living with HIV in USAID-supported states in Nigeria: a retrospective study from 2000–2020

Abstract

Background Patient interruption of antiretroviral therapy (ART) continues to limit HIV programs’ progress toward epidemic control. Multiple factors have been associated with client interruption in treatment (IIT)— including age, gender, CD4 count, and education level. In this paper, we explore the factors associated with IIT in people living with HIV (PLHIV) in United States Agency for International Development (USAID)-supported facilities under the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) program in Nigeria. Methods We conducted cross-sectional analyses on data obtained from Nigeria’s National Data Repository (NDR), representing a summarized record of 573 630 ART clients that received care at 484 PEPFAR/USAID-supported facilities in 16 states from 2000–2020. IIT was defined as no clinical contact for 28 days or more after the last expected clinical contact. Univariate and multivariate logistic regression models were computed to explore the factors associated with IIT. The variables included in the analysis were sex, age group, zone, facility level, regimen line, multi-month dispensing (MMD), and viral load category. Results Of the 573 630 clients analysed in this study, 32% have been recorded as having interrupted treatment. Of the clients investigated, 66% were female (32% had interrupted treatment), 39% were aged 25–34 at their last ART pick-up date (with 32% of them interrupted treatment), 59% received care at secondary level facilities (37% interrupted treatment) and 38% were last receiving between three- to five-month MMD (with 10% of these interrupted treatment). Those less likely to interrupt ART were males (aOR = 0.91), clients on six-month MMD (aOR = 0.01), adults on 2nd line regimen (aOR = 0.09), and paediatrics on salvage regimen (aOR = 0.02). Clients most likely to interrupt ART were located in the South West Zone (aOR = 1.99), received treatment at a tertiary level (aOR = 12.34) or secondary level facilities (aOR = 4.01), and had no viral load (VL) on record (aOR =10.02). Age group was not significantly associated with IIT. Conclusions Sex, zone, facility level, regimen line, MMD, and VL were significantly associated with IIT. MMD of three months and longer (especially six months) had better retention on ART than those on shorter MMD. Not having a VL on record was associated with a considerable risk of IIT.

Predictors of the observed high prevalence of loss to follow-up in ART-experienced adult PLHIV: a retrospective longitudinal cohort study in the Tanga Region, Tanzania

“…Our study found that adults in second-line ART regimens had a higher risk of LTFU than those in the first-line. Our finding is similar to the studies conducted in Nigeria [ 19 , 20 ] and Uganda [ 24 ], which reported a high risk of LTFU in treatment among patients on a second-line regimen. However, the finding is inconsistent with studies [ 31 , 36 ] that found patients on 1st line regimens to have an increased risk of LTFU.…”

“…The prevalence of LTFU in adults PLHIV in the current study was similar to the findings of studies conducted in Nigeria and Gabon, where the cumulative rate of LTFU at 13-and 10-years review in Nigeria was 30.6% and 32% [19,20], while in Gabon in a 2 years review was 34.1% [21]. The study findings are in contrast to the 13.45% LTFU in a retrospective study in Northwest Ethiopia [22], 3% LTFU in a study in France [23], 12.75% LTFU in a retrospective study in Kampala-Uganda [24], 12.8% LTFU in a cohort study in South Africa [25], while a study done in Guinea and Kenya reported a prevalence of 57.61% and 54% LTFU from a 7 years follow-up study [26,27].…”

Predictors of Interruptions in Antiretroviral Therapy among People Living with HIV in Nigeria: A Retrospective Cohort Study Using the Nigeria National Data Repository

“…The Hakizayezu et al study identified other predictors, including a prior history of treatment interruption (which we could not explore as were looking at first interruption) and good perception toward the whole-of-life treatment[13]. Aliyu et al identified additional predictors including HIV viral load indication and result as well as age[17] (which was not predictive in this study or in the Tomescu et al study[16]), and regimen at the start of ART. Other identified predictors in the Tomescu et al study included geo-political zone, regimen line, and viral load suppression[16].…”

“…Logistic regression captured some predictors of IIT, including female sex. In the 2019 study by Aliyu et al[17] 2021 study by Tomescu et al[16], the 2022 study by Hakizayezu et al[13], and a 2020 study by Abebe et al[20] sex was found to be predictive of interruptions in care; however, in all of these studies, the men were at a higher risk of interruption or its proxy such as loss to follow up. Our findings may differ from those of prior studies because we were restricted to those who interrupted but re-engaged in care.…”

“…This retrospective cohort study used medical records from Nigeria’s National Data Repository (NDR). The NDR is a de-identified longitudinal database of over 1.9 million PLHIV who received ART in Nigeria beginning in 2004 and is owned by the Federal Ministry of Health (FMoH)[16]. The data was obtained on the 1 st of November 2021 following a University of Maryland Baltimore (UMB) institutional review board (IRB) determination that the research is nonhuman subject research.…”